Implant Programming. Marie Stopes International. Ghana. George Akanlu, Director Regional Operations. Click to edit footer free text field

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1 Implant Programming Ghana George Akanlu, Director Regional Operations Click to edit footer free text field

2 Ghana Context Limited access to a full range of voluntary family planning services FP choice is limited in rural communities Limited skilled personnel to provide long acting reversible contraception and permanent methods Gaps in availability of commodities at facility level Costs and access barriers

3 Contraceptive use Contraceptive Method Mix Similar proportion of contraceptive use in urban and rural areas but variations between regions Volta has the highest CPR at 32% and Northern the lowest at 11% Pill 16% Other 15% Implants 18% Condom 11% IUD 2% Female S 2% Male S 0% LAM 0% CPR by Region Injectables 36% CPR use Key takeaway: Implants more preferred LARCs. Jadelle most preferred implants 3

4 8 Mobile Clinical Outreach/Inreach Teams & 2 Public Sector Strengthening Teams 9 Centres of excellence Static centres provide all services in urban and peri-urban settings We run mobile clinics on a rotation basis, taking services to locations with limited infrastructure, such as remote rural locations urban slums, and public sector facilities. Call Center: Marie Call A dedicated call centre to provide information and referrals to services 130 BlueStar Social Franchises BlueStar is MSI s network of trained and qualityassured private clinical providers. 52 MS Ladies MS Ladies are midwives, nurses or community health workers who work as self-employed providers in their own communities. MSIG Service Delivery Models Marie MarieStopes StopesInternational International

5 Clinical Quality Recruitment, training & competency assessment to ensure competent service providers Dissemination of clinical guidelines Quarterly comprehensive supportive supervisory visit Annual internal and external quality assurance audits Annual refreshers for providers (counseling is key) Ensuring infection prevention measures are in place Improved/encouraged incident reporting and management

6 Implant Provision in MSIG s Service Delivery Channels

7 Estimated proportion of Voluntary FP nationally provided by MSI Total Voluntary FP LAPM Jadelle and implanon NXT are the two products in Ghana Jadelle is more preferred Until 2015, implant services were provided by mid-wives. Trained and certified Community Health Nurses (CHNs) can now provide implants. MSIG trains all providers in our service delivery channels (includes franchised private and PSS facilities) Source: MSI Impact 2 Estimater

8 Spotlight: Reaching Clients at MSIG Static Centres and Social Franchisees FP awareness raising activities (satisfied client videos, community durbars, market storms etc) Community mobilization for BCC and referrals for voluntary FP through community level workers, Gov t and other orgs Group education sessions, individual counseling and voluntary FP services offered Back-up and referral systems (cross referrals) Quality assurance monitoring and supervision to maintain high service quality Call center offers an anonymous platform for client engagement & referrals Branding

9 Spotlight: Reaching the Underserved through Mobile Clinical Outreach Teams and MS Ladies Providing free voluntary FP services to the doorsteps of clients (in reach for Kayayes and outreach to other under served communities) Awareness raising activities (satisfied client videos, community durbars) Community mobilization for BCC and referrals for FP through public sector health promoters. Targeted mass media campaigns Quality assurance monitoring and supervision to maintain high service quality

10 MSIG Voluntary FP Method Mix All Channels Injectables Pills & EC IUDs Implants Tls Vas 93,832 80,009 73,131 61,601 65,156 68,162 45,716 45,288 53,490 54,534 54,613 55,537 53,795 52,401 34,073 34,176 36,624 31,674 34,476 23,017 14,433 14,182 6,438 7,803 8,743 7,824 2,418 2, ,730 1,578 1, , , *

11 Proportion of Implants Removals Per Channel 18% 16% 16% Major Reasons: 14% 12% 10% 13% 12% 9% 9% 11% Changes in menstrual cycle (majority) Request by husbands/relatives 8% 6% 5% 6% 6% 6% 7% Ready to have a child 4% 4% 4% 2% 1% 1% 1% 2% 0% Removal in Centers Removal in BS Removal in Outreach 0% 0% 0% Removal in PSS Removal in MS Ladies

12 Client/provider insight Client Implant insertion less invasive Less/no pain during insertion Jadelle is preferred to Implanon longer years of protection. Free implant services accessible from mobile teams. Provider Implanon easy to insert because of its single rod Providers more proficient in implant insertion compared to IUD More providers trained in implant insertion (Nurse Aids etc) FP compliance

13 Specific Programmatic Challenges Generally low uptake of LARCs in Ghana due mostly to misconceptions (e.g. implants cause infertility, fibroid etc) Voluntary FP services not included in NHIS benefits package, thus cost is still a barrier. High rate of removal of implants, especially in centers.

14 Thank you Marie MarieStopes StopesInternational International